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A Randomized Controlled Trial of TELEmedicine for Patients with Inflammatory Bowel Disease (TELE-IBD)

Cross, Raymond K., MD, MS1; Langenberg, Patricia, PhD2; Regueiro, Miguel, MD3; Schwartz, David A., MD4; Tracy, J. Kathleen, PhD2; Collins, Joseph F., PhD2,5; Katz, Jonathan6; Ghazi, Leyla, MD1; Patil, Seema A., MD1; Quezada, Sandra M., MD, MS1; Beaulieu, Dawn, MD4; Horst, Sara N., MD, MPH4; Russman, Katharine1; Riaz, Mahrukh, MPH1; Jambaulikar, Guruprasad, MBBS, MPH1; Sivasailam, Barathi, MD1; Quinn, Charlene C., RN, PhD2

American Journal of Gastroenterology: March 2019 - Volume 114 - Issue 3 - p 472–482
doi: 10.1038/s41395-018-0272-8
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INTRODUCTION: Telemedicine has shown promise in inflammatory bowel disease (IBD). The objective of this study was to compare disease activity and quality of life (QoL) in a 1-year randomized trial of IBD patients receiving telemedicine vs. standard care.

METHODS: Patients with worsening symptoms in the prior 2 years were eligible for randomization to telemedicine (monitoring via texts EOW or weekly) or standard care. The primary outcomes were the differences in change in disease activity and QoL between the groups; change in healthcare utilization among groups was a secondary aim.

RESULTS: 348 participants were enrolled (117 control group, 115 TELE-IBD EOW, and 116 TELE-IBD weekly). 259 (74.4%) completed the study. Age was 38.9 ± 12.3 years, 56.6% were women, 91.9% were Caucasian, 67.9% had Crohn’s disease (CD) and 42.5% had active disease at baseline. In CD, all groups experienced a decrease in disease activity (control −5.2 ± 5.0 to 3.7 ± 3.6, TELE-IBD EOW 4.7 ± 4.1 to 4.2 ± 3.9, and TELE-IBD weekly 4.2 ± 4.2 to 3.2 ± 3.4, p < 0.0001 for each of the groups) In UC, only controls had a significant decrease in disease activity (control 2.9 ± 3.1 to 1.4 ± 1.4, p = 0.01, TELE-IBD EOW 2.7 ± 3.1 to 1.7 ± 1.9, p = 0.35, and TELE-IBD Weekly 2.5 ± 2.5 to 2.0 ± 1.8, p = 0.31). QoL increased in all groups; the increase was significant only in TELE-IBD EOW (control 168.1 ± 34.0 to 179.3 ± 28.2, p = 0.06, TELE-IBD EOW 172.3 ± 33.1 to 181.5 ± 28.2, p = 0.03, and TELE-IBD Weekly 172.3 ± 34.5 to 179.2 ± 32.8, p = 0.10). Unadjusted and adjusted changes in disease activity and QoL were not significantly different among groups. Healthcare utilization increased in all groups. TELE-IBD weekly were less likely to have IBD-related hospitalizations and more likely to have non-invasive diagnostic tests and electronic encounters compared to controls; both TELE-IBD groups had decreased non-IBD related hospitalizations and increased telephone calls compared to controls.

DISCUSSION: Disease activity and QoL, although improved in all participants, were not improved further through use of the TELE-IBD system. TELE-IBD participants experienced a decrease in hospitalizations with an associated increase in non-invasive diagnostic tests, telephone calls and electronic encounters. Research is needed to determine if TELE-IBD can be improved through patient engagement and whether it can decrease healthcare utilization by replacing standard care.

1University of Maryland School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Baltimore, MD, USA;

2University of Maryland School of Medicine, Department of Epidemiology and Public Health, Baltimore, MD, USA;

3University of Pittsburgh, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Pittsburgh, PA, USA;

4Vanderbilt University, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Nashville, TN, USA;

5Veterans Affairs Cooperative Studies Program, Perry Point, MD, USA;

6CircleLink Health LLC, Norwalk, CT, USA.

Correspondence: Raymond K. Cross, MD, MS. E-mail: rcross@som.umaryland.edu.

Received November 13, 2017

Accepted August 14, 2018

© The American College of Gastroenterology 2019. All Rights Reserved.
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